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General NPI Number Information
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NPI Number | 1255630414
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Entity Type | Individual
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Provider Name | FREDERICK CHARLES POLSENO JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2011
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Last Update Date | 03/26/2011
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Provider Practice Location Address
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Address Line | 90 QUAKER LN
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City | WARWICK
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State | RI
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Zip | 02886-0111
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Country | US
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Telephone | 401-465-4200
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Fax | 401-821-2895
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Provider Business Mailing Address
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Address Line | 29 WILKINSON RD
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City | NORTH SCITUATE
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State | RI
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Zip | 02857-1027
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Country | US
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Telephone | 401-647-9232
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Fax | 401-821-2895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3941
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License Number State | RI
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